The Japanese Society of Gastroenterological Mass Survey has proposed a new imaging standard for screening gastric cancer by indirect X-ray examination, in which double-contrast images but not barium-filled images in the upright and prone position would be utilized. We examined 172 cases with gastric cancer that had been detected between 1998 and 2000 by the Kumamoto Prefectural Association for Adult Disease Prevention and evaluated screening images as to which were useful in the selection of candidates for further examinations. In addition, review of all images in each case was carried out in order to evaluate the role of barium-filled images. Such images taken in the upright position were used most frequently for selecting candidates for close examinations. There were many cases in which abnormalities had been indicated only by barium-filled images. Although such images have a low positive predictive value, elimination of these images from the standard procedure would result in an increased risk of false-negative results.

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[in Japanese]

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The aim of the present study was to evaluate the advantage of using indirect gastrofluororadiography (XP) and the serum pepsinogen (PG) test in mass screenings for gastric cancer, especially for detecting endoscopically resectable (ER) cancer. A total of 1, 045 cases of gastric cancer were discovered among the 572,956 individuals who underwent the screening program of the Miyagi Cancer Society from April 2001 to November 2003. Of the gastric cancer cases, 371 cases examined with both XP and the PG test were divided into three groups: advanced cancer (invading the muscle layer proper), early cancer (limited in the submucosal layer) and ER cancer. On the one hand, XP had for a better detection rate for advanced cancer in comparison with the PG test (detection rates: XP 942%, PG 70.9%). On the other hand, the PG test had higher detection rates than XP for both early cancer (XP 56.8%, PG 73.3%) and ER cancer (XP 33.3%, PG 79.6%). The positive rates for either examination were 100, 88.7 and 82.8% in advanced, early and ER cancer groups, respectively. These results suggest that XP or the PG test on its own has difficulty in detecting early-stage cancers. It is desirable to detect gastric cancers in the earlier stages, such as ER cancer. The complementary combination of XP and the PG test may contribute to the qualitative improvement of mass screening programs, which are in ever increasing demand recently.

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The aim of this study was to clarify the usefulness of the combined use of the serum pepsinogen (PG) method and the Helicobacter pylori (Hp) antibody value as a screening method for gastric cancer. The evaluation was performed on 1, 218 people (808 male, 410 female, 30-89 years old, mean age 522 years) who underwent the PG test and the Hp antibody value test from April 1996 to March 1997. We defined those subjects who had levels of PG I lower than 70 ng/ml and a PG I/II ratio of less than 3.0 as positive for PG. Consequently, all subjects were classified into 3 groups on the basis of the blood test results for Hp antibody and the PG test: group A consisted of the subjects with negative Hp antibody (-) and negative PG (-) ; group B consisted of the subjects with positive Hp antibody (+) and negative PG (-) ; group C consisted of the subjects who had positive PG (+). There were 260 cases (21.3%) in group A, 571 cases (46.9%) in group B, and 312 cases (25.6%) in group C. There were also 75 cases (62%) which were indeterminable in the HP test. We investigated the development of gastric cancer and adenoma after the blood test by reviewing endoscopic files and pathological files dated up to March 2003. Thirteen gastric cancer cases were found in the follow-up examination, of which 7 cases belonged to group C and 6 cases to group B; no gastric cancer case belonged to group A. The detection rate for gastric cancer was 224% in group C, 1.05% in group B, 0% in group A. In the follow-up examination, 5 cases of gastric adenoma were found, all in the group C. These results suggest that the combined use of the serum PG method and the Hp antibody value test is useful for gastric cancer screening. And we consider that the evaluation of gastric health in the subjects is possible by checking the presence of Hp infection and gastric mucosal atrophy with a blood test.

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To perform the endoscopic screening of the stomach efficiently, it is necessary to settle the intervals of the examination according to the risk of gastric cancer development. Therefore, we examined acceptable intervals of endoscopic screening by analyzing the relationship between type of Helicobacter pylori (Hp)-associated chronic gastritis and gastric cancer development (1), and we estimated the intervals by using values of serum pepsinogens (2). We examined 1,526 people who received gastric endoscopy annually for the study 1, and 498 people who received gastric endoscopy and serum pepsinogens test for the study 2. Gastric cancer was developed in 36 patients in the study 1. The rates of gastric cancer development was 1.43% year, 0.75%· year, 0.049%·year and 0%·year, in the patients with corpus-predominant gastritis, in the patients with pangastritis, in the patients with antrum-dominant gastritis and in the Hp-negative subjects, respectively. The Hpnegative subjects and the patients with antrum-predominant gastritis may be low-risk of gastric cancer development, and the patients with corpus-predominant gastritis and with pangastritis may be high-risk. One of each 5 year screening may be enough for the low-risk group. Values of serum pepsinogens can distinguish the low-risk group and the high-risk group.

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Systematic endoscopy screening is fundamental for the early detection of gastrointestinal cancer. However, there are some important points that need to be addressed. One of them is the low number of endoscopists compared to the demand for examinations. Thus, a new digital image filing system with real-time reporting function using a touch panel has been developed, in order to facilitate the endoscopist's work between examinations. Diagnoses are easily input during the examination, and so the endoscopist can be released from the routine work of intricate input by mouse and keyboard after the examination. Furthermore, real-time input enables the construction of an accurate database. The total examination time is shortened with this system, and we can utilize the time remaining after the procedures to check the endoscopic images and build up our database.
The first-time user must become familiar with the system, especially with the chang es in the screen structure.
This new digital image filing system is a promising tool for systematic endoscopy screening.

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[in Japanese]

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